Local care for low-birth-weight Infants
By Srisatish Devapatla, MD
On May 24, 2007, the Ithaca Journal
ran an Associated Press article entitled, “Study: Closing small neonatal ICUs
could save more preemies.” The article attempted to briefly summarize a large
study of infant and fetal deaths in California hospitals that was published in
the New England Journal of Medicine. The
article was confusing for local readers, however, because it did not include
information specific to local neonatal services at Cayuga Medical Center, and,
as a result, it raised more questions than it answered.
What level of neonatal care is
Cayuga Medical Center is certified
by the NYS Department of Health to provide Level 2 nursery services. In
accordance with the American Academy of Pediatrics, our Special Care Nursery is
classified as a Level 2B nursery because we are qualified to provide mechanical
ventilation for brief duration or continuous positive airway pressure, which
are both designed to help babies who need assistance breathing. To offer this
level of care, we have specialized equipment and personnel available around the
clock to provide ongoing care and to handle emergency situations as they arise.
What’s the definition of a
The study summarized in the May 24
article analyzed mortality rates among “very-low-birth-weight infants.” By
definition, these are infants who weigh less than 3 lbs, 3 oz. at birth (less
than 1,500 grams). Researchers in the study focused on babies weighing between
1 to 3 pounds.
At Cayuga Medical Center, our
Special Care Nursery is certified to care for “low-birth-weight infants,” which
encompasses babies who weigh between 3 lbs, 3 oz and 5 lbs, 5 oz., and who have
had at least a 32-week gestation period. The average gestation period for
humans is 40 weeks, which means that we can care for babies up to eight weeks
premature, provided they weigh over 3 pounds.
When there is an impending delivery
of a baby of less than 32 weeks gestation, we transfer the mother to the
closest tertiary-care center. However, if the baby is already on the way, we
deliver and quickly stabilize the infant at Cayuga Medical Center, and then
transfer him or her to the nearest tertiary-care center.
What role do obstetrical services
The May 24 article noted that
hospitals with better neonatal units also had round-the-clock anesthesiology
and obstetrical coverage to handle emergency deliveries: mortality rate of
premature and low-birth-weight infants does correlate with the level of
obstetrical care available. The Maternal-Child Care staff and neonatologist at
Cayuga Medical Center have worked closely with our obstetricians and
anesthesiologists to meet this requirement. We have streamlined our processes
in providing emergency care to obstetrical patients, including emergency
On average, how many
low-birth-weight babies are born and receive care at Cayuga Medical Center?
The Special Care Nursery has been a
designated Level 2 for over four years. Last year 45 low-birth-weight babies
received care in our Special Care Nursery, which is less than 6 percent of the
babies born here.
Will the study published in the New England Journal of Medicine have any
The study is interesting and
certainly helpful to those hospitals providing care to very-low-birth-weight
babies. However, the study is less helpful to Tompkins County because it didn’t
focus on the exact level of care and service we offer and the specific size and
age of premature babies for which we provide care. Additionally, Cayuga Medical
Center is the only acute care provider in this rural region. Without a
certified Special Care Nursery here, the community would experience an increase
in infant mortality and morbidity. Finally, our infant mortality rate for
low-birth-weight babies is excellent: since becoming certified more than four
years ago as a Level 2 nursery with 24-hour coverage by a board-certified
neonatologist, we have not lost a low-birth-weight baby who would otherwise
have survived in a tertiary care facility.
Since coming on staff at Cayuga
Medical Center five years ago, I have been continually impressed with this
medical center’s physician specialists, nursing staff, respiratory therapists,
medical technologists, echocardiology technicians, and imaging technologists in
their commitment to meet a very high standard of care for newborns. Our team is
very experienced, highly trained, and very compassionate as we strive to
provide local care that enables families to remain together, which is crucial
for the wellbeing of premature and low-birth-weight babies.
Devapatla is board certified in neonatal-perinatal medicine and pediatrics and
is medical director of the Special Care Nursery at Cayuga Medical Center. He
completed a fellowship in neonatal-perinatal medicine at Case Western Reserve
University after finishing his residency in pediatrics at Metropolitan Hospital
Center, New York Medical College.